<%@ page language="java" contentType="text/html; charset=utf-8"
	pageEncoding="utf-8"%>
<%@ include file="/commons/taglibs.jsp"%>
<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<meta name="renderer" content="webkit">
<meta http-equiv="Cache-Control" content="no-siteapp" />
<title>会员信息服务</title>
<%@ include file="/commons/static.jsp"%>
<link rel="shortcut icon" href="${ctx }/home/common/img/favicon.png"
	type="image/x-icon">
</head>
<style>
			i{color:#00a2ca;}
			i{padding-right: 5px;white-space:nowrap;}
		</style>
	</head>

	<body>
		<div class="col-lg-8  col-md-12 col-sm-12 col-xs-12 col-lg-offset-2">
			<div class="widget">
				<div class="widget-header">
					<h2 class="text-center">体检调查</h2>
				</div>
				<div class="widget-body" style="overflow:hidden">
					<div class="col-lg-12 col-sm-12 col-xs-12 ">
						<div class="widget">
							<section name="section1" id="sec2">
								<form class="form-horizontal form-bordered" id="form" action="${ctx }/customer/saveSurveyRepor" method="post" role="form">
								<input id="customerId" value="${id }" hidden name="customerId" />
								<input id="id" value="${re.id }" hidden name="id" /> 
								<input id="content" hidden name="contentChemical" />
								<input id="contentType" hidden name="contentType" />
									<div class="bancgud row">
										<div class="formfont wjdc_top col-lg-12"><img src="${ctx }/dep/img/wenjuan.png">
											<span class="No">NO.1</span>
											<span class="inform">个人体检信息</span></div>
										<!--<div class="formfont col-lg-12">二  个人体检信息</div>-->
										<h4 class="block col-lg-12">
											<i class="fa fa-exclamation-circle" id="t1"></i>
											1.一般检查（1尺=33.3厘米）</h4>
										<div class="col-lg-4">
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													身高<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" class="form-control" id="group_1_height_text" name="group_1_height_text" tab="tab_1" t="t1">
														<span class="input-group-addon">cm</span>
													</div>
												</div>
											</div>
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													体重<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" id="group_1_weight_text" name="group_1_weight_text" tab="tab_1" t="t1" class="form-control">
														<span class="input-group-addon">kg</span>
													</div>
												</div>
											</div>
										</div>
										<div class="col-lg-4">
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													臀围<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" id="group_1_hip_text" name="group_1_hip_text" tab="tab_1" t="t1" class="form-control">
														<span class="input-group-addon">cm</span>
													</div>
												</div>
											</div>
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													腰围<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" id="group_1_waistline_text" name="group_1_waistline_text" tab="tab_1" t="t1" class="form-control">
														<span class="input-group-addon">cm</span>
													</div>
												</div>
											</div>
										</div>
										<div class="col-lg-4">
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													收缩压<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" id="group_1_sbp_text" name="group_1_sbp_text" tab="tab_1" t="t1" class="form-control">
														<span class="input-group-addon">mmHg</span>
													</div>
												</div>
											</div>
											<div class="form-group">
												<label class="col-sm-3 control-label no-padding-right">
													舒张压<span class="help-inline"></span></label>
												<div class="col-sm-9">
													<div class="input-group">
														<input type="text" id="group_1_dbp_text" name="group_1_dbp_text" tab="tab_1" t="t1" class="form-control">
														<span class="input-group-addon">mmHg</span>
													</div>
												</div>
											</div>
										</div>
										<h4 class="block col-lg-12">
											<i class="fa fa-exclamation-circle" id="t2"></i>
											2.心电图检查（每项单选）</h4>
										<table class="table table-striped table-hover table-bordered">
											<tbody>
												<tr>
													<td width="25%">早搏</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_vpb1_radio" value="1" 
name="group_1_vpb_radio"  data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_vpb2_radio" value="2"
name="group_1_vpb_radio" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_vpb3_radio" value="3"
name="group_1_vpb_radio" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">ST-T改变</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input  tab="tab_1"
t="t2"	type="radio" id="group_1_st1_radio" value="1"
name="group_1_st_radio" data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_st2_radio" value="2"
name="group_1_st_radio" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_st3_radio" value="3"
name="group_1_st_radio" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">房颤</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_eee1_radio" value="1"
name="group_1_eee_radio" data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_eee2_radio" value="2"
name="group_1_eee_radio" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_eee3_radio" value="3"
name="group_1_eee_radio" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">左心房肥大</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_lha1_radio" value="1"
name="group_1_lha_radio" data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_lha2_radio" value="2"
name="group_1_lha_radio" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input tab="tab_1"
t="t2"	type="radio" id="group_1_lha3_radio" value="3"
name="group_1_lha_radio" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
											</tbody>
										</table>
										<h4 class="block col-lg-12">
											<i class="fa fa-exclamation-circle" id="t3"></i>
											3.X线和B超检查（每项单选）</h4>
										<table class="table table-striped table-hover table-bordered">
											<tbody>
												<tr>
													<td width="25%">肝脂肪</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_axunge_radio"
id="group_1_axunge1_radio" value="1" data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input  t="t3" tab="tab_1"
type="radio" name="group_1_axunge_radio"
id="group_1_axunge2_radio" value="2" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_axunge_radio"
id="group_1_axunge3_radio" value="3" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">胆结石</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_gallStone_radio"
id="group_1_gallStone1_radio" value="1"   data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_gallStone_radio"
id="group_1_gallStone2_radio" value="2" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_gallStone_radio"
id="group_1_gallStone3_radio" value="3" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">肾结石</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_kidneyStone_radio"
id="group_1_kidneyStone1_radio"  data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_kidneyStone_radio"
id="group_1_kidneyStone2_radio" value="2" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_kidneyStone_radio"
id="group_1_kidneyStone3_radio" value="3" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
												<tr>
													<td width="25%">乳房良性结节或肿块</td>
													<td>
														<div class="collabe">
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_knur_radio"
id="group_1_knur1_radio" value="1" data-bv-field="d">
                                                    <span class="text">无</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_knur_radio"
id="group_1_knur2_radio" value="2" data-bv-field="d">
                                                    <span class="text">有</span>
                                                </label>
															<label class="labletab col-sm-2">
                                                    <input t="t3" tab="tab_1"
type="radio" name="group_1_knur_radio"
id="group_1_knur3_radio" value="3" data-bv-field="d">
                                                    <span class="text">不清楚</span>
                                                </label>
														</div>
													</td>
												</tr>
											</tbody>
										</table>
										<h4 class="block col-lg-12">4.实验室检查</h4>
										<table class="table table-striped table-hover table-bordered">
											<thead>
												<tr>
													<th width="20%">体检项目</th>
													<th width="10%">体查值</th>
													<th width="10%">单位</th>
													<th width="20%">体检项目</th>
													<th width="10%">检查值</th>
													<th width="10%">单位</th>
												</tr>
											</thead>
											<tbody>
												<tr>
													<td>胆固醇(TC)</td>
													<td>
														<input type="text"  name="group_1_tc_text" id="group_1_tc_text"  class="form-control" value="2.00">
													</td>
													<td>
														<select id="group_1_tcTag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
													<td>高密度脂蛋白胆固醇</td>
													<td><input type="text" id="group_1_htc_text" name="group_1_htc_text" class="form-control" value="2.00"></td>
													<td>
														<select id="group_1_htcTag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
												</tr>
												<tr>
													<td>甘油三脂(TG)</td>
													<td>
														<input type="text" id="group_1_tg_text" name="group_1_tg_text" class="form-control" value="2.00">
													</td>
													<td>
														<select id="group_1_tgTag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
													<td>低密度脂蛋白胆固醇</td>
													<td><input id="group_1_ldl_text" name="group_1_ldl_text" type="text" class="form-control" value="2.00"></td>
													<td>
														<select id="group_1_ldlTag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
												</tr>
												<tr>
													<td>空腹血糖(GLU)</td>
													<td>
														<input type="text" id="group_1_glu_text" name="group_1_glu_text" class="form-control" value="2.00">
													</td>
													<td>
														<select id="group_1_gluTag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
													<td>餐后2小时血糖</td>
													<td><input type="text" id="group_1_eat2_text" name="group_1_eat2_text" class="form-control"></td>
													<td>
														<select id="group_1_eat2Tag_select">
															<option value="1">mmol1/L</option>
															<option value="2">mmol2/L</option>
															<option value="3">mmol3/L</option>
														</select>
													</td>
												</tr>
												<tr>
													<td>血红蛋白(HGB)</td>
													<td>
														<input type="text" name="group_1_hgb_text" id="group_1_hgb_text" class="form-control" value="">
													</td>
													<td>g/l</td>
													<td>血尿酸(UA)</td>
													<td><input type="text" id="group_1_uc_text" name="group_1_uc_text" class="form-control"></td>
													<td>umol/L</td>
												</tr>
												<tr>
													<td>谷丙转氨酶(HGB)</td>
													<td>
														<input type="text" id="group_1_alt_text" name="group_1_alt_text" class="form-control" value="">
													</td>
													<td>IU/L</td>
													<td>乙肝表面抗原(HBsAg)</td>
													<td colspan="2">
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_hasag1_checkbox" value="1"
name="group_1_hasag_checkbox">
                                                <span class="text">阳性</span>
                                            </label>
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_hasag2_checkbox" value="2"
name="group_1_hasag_checkbox">
                                                <span class="text">阴性</span>
                                            </label>
													</td>
												</tr>
												<tr>
													<td>谷草转氨酶(AST)</td>
													<td>
														<input type="text" id="group_1_ast_text" name="group_1_ast_text" class="form-control" value="">
													</td>
													<td>IU/L</td>
													<td>丙型肝炎抗体(HCV)</td>
													<td colspan="2">
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_hcv1_checkbox" value="1"
name="group_1_hcv_checkbox">
                                                <span class="text">阳性</span>
                                            </label>
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_hcv2_checkbox" value="2"
name="group_1_hcv_checkbox">
                                                <span class="text">阴性</span>
                                            </label>
													</td>
												</tr>
												<tr>
													<td>尿蛋白(PRO)</td>
													<td colspan="2">
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_pro1_checkbox" value="1"
name="group_1_pro_checkbox">
                                                <span class="text">阳性</span>
                                            </label>
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_pro2_checkbox" value="2"
name="group_1_pro_checkbox">
                                                <span class="text">阴性</span>
                                            </label>
													</td>
													<td>大便隐血(HCV)</td>
													<td colspan="2">
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_so1_checkbox" value="1"
name="group_1_so_checkbox">
                                                <span class="text">阳性</span>
                                            </label>
														<label class="col-sm-6">
                                                <input type="checkbox" id="group_1_so2_checkbox" value="2"
name="group_1_so_checkbox">
                                                <span class="text">阴性</span>
                                            </label>
													</td>
												</tr>
												<tr>
													<td>甲胎蛋白(AFP)</td>
													<td>
														<input type="text" id="group_1_afp1_text" name="group_1_afp1_text" class="form-control" value="">
													</td>
													<td>IU/L</td>
													<td>癌胚抗原(CEA)</td>
													<td>
														<input type="text" id="group_1_cea_text" name="group_1_cea_text" class="form-control" value="">
													</td>
													<td>ug/l</td>
												</tr>
												<tr>
													<td>C反应蛋白(CRP)</td>
													<td>
														<input type="text" id="group_1_crp_text" name="group_1_crp_text" class="form-control" value="">
													</td>
													<td>mg/L</td>
													<td>前列腺特异抗原(PSA)</td>
													<td>
														<input type="text" id="group_1_psa_text" name="group_1_psa_text" class="form-control" value="">
													</td>
													<td>ug/l</td>
												</tr>
												<tr>
													<td>血肌肝(Cr)</td>
													<td>
														<input type="text" id="group_1_cr_text" name="group_1_cr_text" class="form-control" value="">
													</td>
													<td>umol/L</td>
													<td>骨密度检测指标-T值</td>
													<td>
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	<script src="${ctx}/home/member/surveyRepor.js"></script>
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